Annual Financial Report For Charitable Organizations Form Page 4
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4SCHEDULE 4: CONTRACTS WITH COMMERCIAL CO-VENTURERS (CCV)
Please see instructions attached. If insufficient room in the form below, copy this form and attach sheet.
ITEM
EVENT
EVENT
EVENT
1. Brief Description of
Sale or Event
2. Date or Period Covered
3. CCV Name and Address
4. Brief description of financial
terms and conditions
of written contract
5. Has your organization
YES _____
YES _____
YES _____
received an accounting
NO _____
NO _____
NO _____
from the CCV?
6. Net proceeds to charity for
each campaign or event*
* Transfer net proceeds to the charity for all events from Line 6 above to Schedule 1, Line 3.
SCHEDULE 5: SPECIAL EVENTS & FUNDRAISING SALES
ITEM
EVENT
EVENT
EVENT
1.
Description of Event/Sale
2.
Date(s) of Event/Sale
3.
Gross Receipts
4.
Direct Expenses*
5. Adjusted Gross**
* Direct Expenses mean the cost of any food, beverage, entertainment, rent and maintenance of building involved in a special event
or the cost of any product or service sold. Also, include in Line 4 any taxes and any fees paid to professional fundraising
counsels or solicitors who assisted with the sale or event such as a bingo game.
** Transfer Adjusted Gross to Schedule 1, Line 5, "Special Events."
CERTIFICATION
As required by Section 33-56-30 of the Solicitation of Charitable Funds Act, this form shall be signed by the Chief
Executive Officer and the Chief Financial Officer of the charitable organization. (If one person serves as both CEO and
CFO, he or she should sign in both places below.)
WE CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT IS TRUE AND CORRECT TO
THE BEST OF OUR KNOWLEDGE AND BELIEF.
_______________________________________________________________________ ______________________________
Signature of Chief Executive Officer
Date
_______________________________________________________________________ ______________________________
Signature of Chief Financial Officer
Date
X:\FORMS\EXTERNAL\Annual Financial Report Form.doc Rev. 3/6/2002
Page 4 of 4 Pages
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